August 27, 2003
Diagnosis and Symptoms
Question from Bentonville, Arkansas, USA:
Our 13 year old son (5 feet 1inch tall, 95 pounds) is a healthy, active, extremely bright kid. He has played on a “travel” soccer team for four years and practices frequently, and after a particularly tough practice, he collapsed on the field. He had trouble focusing, couldn’t grip with his hands, and was too wobbly to walk. He appeared to have heat exhaustion. We got him into a cool tub and called the doctor who told us to get him to the ER.
He was given IV fluids and seemed to feel somewhat better, but his blood sugar was found to be 240 mg/dl [13.3 mmol/L]. The doctor was (is) convinced that no healthy person reacts to physical stress/heat exhaustion with increased sugar levels and told us that he is pretty confident that he has type 1 diabetes, but he has not shown any of the classic symptoms. His A1c was 5.3%, his islet cell antibody test was negative, and we are waiting for the GAD antibody test results.
We have been testing him each morning, and his fasting glucose levels have not been higher than 90 mg/dl [5 mmol/L]. As we wait for the results of the final tests, the doctor has us checking his levels just before and just after soccer practice. He had a snack after school (protein and carb), and we checked his glucose level before practice which was 106 mg/dl [5.9 mmol/L]. After playing soccer in the heat index of about 105 degrees F, the coach had the boys running sprints. He did two and vomited so I got him in the shade. He looked fine, said he felt better, was not tired, and showed none the signs that he had presented before. I checked his sugar level at the field and it was 132 mg/dl [7.3 mmol/L], and at home it was 126 mg/dl [7 mmol/L]. He ate dinner, and when I checked the level two hours later, it was 128 mg/dl [7.1 mmol/L]. He panicked because these were the first tests that we’ve done that were over 100 mg/dl [5.6 mmol/L].
Should I be concerned? Could his levels rise during exercise? Will the GAD test confirm the diabetes? Where do we go from here?
A positive GAD antibody level does not confirm diabetes, merely the risk to develop it, and not everyone who is positive does. If positive, you may want to inquire about an intravenous glucose tolerance test with first phase insulin release which is usually done at a center. I don’t know if I would do it to my child, but it is a choice to look at insulin reserve.
The glucoses you write about are not diabetes. I agree the 240 mg/dl [13.3 mmol/L] is a bit high for stress, but I have seen it, worried about it, and only one time in 25 years have I seen the child go to diabetes later. At present, I would likely test the urine before bed for glucose. It is after a meal, and reflects the rise after the big meal. If negative for a while, I would stop testing and be vigilant for the classic symptoms of diabetes, especially at night.